PBL Drugs

Question 1

ACE Inhibitors

Answer 1

• captopril, enalapril, lisinopril, ramipril
• inhibit ACE decreasing angiotensin II
  
  • ​bradykinin ACTIVE
  • increased renin levels
  • • used w/hypertension and HF
• CATCHH - cough, angioedema, teratogen, creatine increased, hyperkalemia

Question 2

Angiotensin II receptor blockers

Answer 2

• Lorsartan, Candesartan, Valsartan
• block binding of angiotensin II to angiotensin II receptor
  
  • BP is reduced
  • vessels vasodilate
• hypertension, HF
• hyperkalmeia, decreased renal function, hypotension

Question 3

K+ sparing diurectics

Answer 3

• Spironolactone, Eplerenone - triamterene, Amiloride
• MOA: competitive aldosterone receptor antagonists in cortical collecting tubule
• Use = Heart failure, K+ depletion
• AE = hyperkalemia, endocrine effects

Question 4

Thiazides

Answer 4

• chlorthalidone, hydrochlorothiazide
• inhibits NaCL reabsorption in e_arly distal convoluted tubule_
• hypertension, heart failure
• AE = hyperglycemia, hyperlipidemia, hyperuricemai, hypokalemic metabolic alkalosis, hypercalcemia
• used first line for hypertension

Question 5

Loop diuretics

Answer 5

• Furosemide, Bumetanide, Torsemide
• inhibits Na/K/2Cl of thick ascending limb of loop of Henle
  
  • ​reduces PRELOAD + peripheral vascular resistance
  • Increases venous capacitance
    
    • prevents concentration of urine
    • stimulates PGE release for vasodilation
    • increases calcium secretion
• Heart failure, cirrhosis, hypertension, nephrotic syndrome
• OH DANG - ototoxicity, hypokalemia, dehydration, allergy to sulfa, nephritis, gout

Question 6

B-blockers

Answer 6

• decrease cardiac output, decrease renin secretion due B receptor blockade.
• Decrease SA and AV nodal activity by decreasing calcium currents
  *

Question 7

HMG-CoA reductase inhibitors

Answer 7

• statins
• inhibit conversion of HMG-CoA to mevalonate - stops cholesterol synthesis
• decrease triglycerides, LDL
• increase HDL

Question 8

Bile Acid Resins

Answer 8

• prevent intestional absorption of bile acids - liver must then use cholesterol to make more
• decreases LDL
• ex are cholestyramine, colestipol, colesevelam

Question 9

Ezetimibe

Answer 9

• prevents cholesterol absorption at small intestine
• large decrease in LDL

Question 10

Fibrates

Answer 10

• gemfibrozil, clofibrate, benzafibrate, fenofibrate
• upregulate lipoprotein lipase which increases triglyceride clearance
• activates PPAR-a to induce HDL synthesis

Question 11

Niacin

Answer 11

• inhibits lipolysis in adipose tissue
• decreases hepatic VLDL synthesis

Question 12

Non selective beta blockers

Answer 12

propranolol

pindolol

nadolol

timolol

Question 13

Tx for MI

Answer 13

• reperfusion
• Aspirin (or clopidogrel)
• ACE and Beta to reduce mortality in first 24 hours
• Nitro - relieve preload
• Anticaogs
• GP IIb/IIIa inhibitors for stenting

Question 14

Tx for hypertension

Answer 14

• thiazide diuretics
• ACE (or ARB)
• Calcium channel blocker
• Beta blcoker - not first line
• Alpha 1 blocker (prazoin) - reduces TPR
• Aliskiren - renin inhibitor

Question 15

Tx for heart failure

Answer 15

• symptomatic treatment with diuretics
• ACE - reduces afterload and imporves mortality
• Beta blocker - especially w/right sided heart failure
• Hydralazine - direct vasodilator
• Digoxin or dobutamine to imporve contractiliy - use if on Beta blocker and ACE and still have low EF
• anticoags and platlets could reduce risk of thrombotic event